MEDICARE: DR. JONATHAN DANIEL KIVITZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G56796	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G56796	OTHER	CA	CALIFORNIA LISCENSE

General Provider Information

NPI Number	:	1790789683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN DANIEL KIVITZ M.D.

Provider Business Mailing Address
First Line	:	435 N ROXBURY DR STE 311
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5005
Country	:	US
Telephone Number	:	310-201-0355
Fax Number	:	310-657-0986

Provider Business Practice Location Address
First Line	:	435 N ROXBURY DR STE 311
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5005
Country	:	US
Telephone Number	:	310-201-0355
Fax Number	:	310-657-0986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/26/2010

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